ANAL CONDITIONS

Anal disorders are not uncommon or anything to be embarrassed about – in fact most people experience some form of anorectal disroder during their lifetime.

Many anal disorders can be painful but most usually are not serious. However, any anal condition, especially if bleeding is present, should be evaluated by a colon and rectal surgeon to rule out a more serious problems.

Anal Abscess

Patients who feel ill and complain of chills, fever and pain in the rectum or anus could be suffering from an anal abscess or fistula. These are common ailments, but not most people know very little about it.

What is an anal abscess?
An anal abscess is an infected cavity filled with pus found near the anus or rectum.

What is an anal fistula?
An anal fistula is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus. They are almost always the result of a previous abscess.

What causes an anal abscess?
An abscess results from an acute infection of a small gland just inside the anus, when bacteria or foreign matter enters the tissue through the gland. Certain conditions including colitis or other inflammation of the intestine, can make these infections more likely.

What causes a fistula?
After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin. If this occurs, persistent drainage from the outside opening may indicate the presence of this tunnel. If the outside opening of the tunnel heals, recurrent abscess may develop.

What are the symptoms of an abscess or fistula?
Symptoms of both ailments include constant pain, sometimes accompanied by swelling, that is not necessarily related to bowel movements. Other symptoms include irritation of skin around the anus, drainage of pus (which often relieves the pain), fever, and a general feeling of not feeling well.

Does an abscess always become a fistula?
No. A fistula develops in about 50 percent of all abscess cases, and there is really no way to predict if this will occur.

How is an abscess treated?
An abscess is treated by draining the pus from the infected cavity, making an opening in the skin near the anus to relieve the pressure. Often this can be done in our office using a local anesthetic.

A large or deep abscess may require hospitalization and use of a different anesthetic method. Hospitalization may also be necessary for patients prone to more serious infections, such as diabetics or people with decreased immunity. Antibiotics are not usually an alternative to draining the pus, because antibiotics are carried by the blood stream and do not penetrate the fluid within an abscess.

How are fistulas treated?
Surgery is necessary to cure an anal fistula. Although fistula surgery is usually not invasive, the potential for complication does exists, and should be performed by a colon and rectal surgeon.

Fistula surgery may be performed at the same time as abscess surgery, although fistulas often develop four to six weeks after an abscess is drained sometimes even months or years later. Fistula surgery usually involves cutting a small portion of the anal sphincter muscle to open the tunnel, joining the external and internal opening and converting the tunnel into a groove that will then heal from within outward. Most fistula surgery can be performed on an outpatient basis – or with a short hospital stay.

How long does recovery take?
Treatment of an abscess or fistula is followed by resting at home and soaking the affected area in a sitz bath 3-4 times a day. Some patients feel discomfort or pain that can be controlled with medication. Stool softeners may also be recommended. It may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes.

After surgery the amount of time lost from work is usually minimal and most patients can return to normal activity within a week.

What are the chances of a recurrence of an abscess or fistula?
If properly healed, the problem will usually not return. However, it is important to follow the directions of your CRS surgeon to prevent recurrence.

Pruritus Ani

What is Pruritus Ani?
This is a common condition causing itching around the anal area and irresistible urge to scratch. It may be most noticeable and bothersome at night or after bowel movements.

What causes this to Pruitus Ani?
Several factors may contribute. A common cause is excessive cleaning of the anal area. Moisture around the anus, from excessive sweating or from moist, sticky stools, is another possible cause. In some people, a loose and/or irritating stool may be caused by a high intake of liquids.

For some people certain beverages including milk, citrus fruit juices, drinks containing caffeine, such as coffee, tea and cola, and some alcoholic beverages, especially beer, may contribute.

Similarly, some foods that can contribute to the problem are chocolate, fruits, tomatoes, nuts and popcorn.

Does Pruritus Ani result from lack of cleanliness?
Cleanliness is almost never a factor. However, the natural tendency once a person develops this itching is to wash the area vigorously and frequently with soap and a washcloth. This almost always makes the problem worse by damaging the skin and washing away protective natural oils.

What can be done to make this itching go away?
A careful examination by a colon and rectal surgeon or other physician may identify a definite cause for the itching. Your physician can recommend treatment to eliminate the specific problem.

Treatment of pruritus ani include avoiding further trauma to the affected area:

Do not use soap of any kind on the anal area

Do not scrub the anal area with anything – even toilet paper

For hygiene, use wet toilet paper, baby wipes or a wet washcloth to blot the area clean, do not rub

Try not to scratch the itchy area, this produces more damage, which in turn makes the itching worse

You should also avoid moisture in the anal area.

Apply either a few wisps of cotton, a 4 x 4 gauze or some cornstarch powder to keep the area dry

Avoid all medicated, perfumed and deodorant powders

Use only medications prescribed by your physician and use them only as directed. Apply prescription medications sparingly to the skin around the anal area and avoid rubbing.

Avoid excess fluids and the foods previously mentioned. In most cases, a maximum of six glasses of fluid daily is enough. There is not usually any health benefit to drinking more fluid than this in the course of a day.

How long does treatment usually take?
Most people experience some relief from itching within a week. Complete cure usually comes within four to six weeks. A follow up appointment with your colon and rectal surgeon may be recommended to prevent recurrence of pruritus ani.

Anal Fissure

What is an Anal Fissure?
An anal fissure is a small tear in the lining of the anus which can cause pain, bleeding and/or itching.

What causes an Anal Fissure?
A hard, dry bowel movement can cause a tear in the anal lining, resulting in a fissure. Other causes of a fissure include diarrhea and inflammation of the anorectal area.

How can a Fissure be treated?
At least 50 percent of fissures heal either by themselves or with non-operative treatment, including application of special medicated cream, use of stool softeners, avoidance of constipation, and the use of sitz baths (soaking the anal area in plain warm water for 20 minutes, several times a day).

What can be done if a Fissure doesn’t heal?
A fissure that fails to respond to treatment should be re-examined to determine if a definitive reason exists for lack of healing. Such reasons can include scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain and/or bleeding can be corrected by surgery.

What does surgery involve?
Surgery may consist of a small operation to remove the fissure and the underlying scar tissue. Cutting a portion of one of the anal muscles helps the fissure to heal by preventing pain and spasm, which interferes with healing. Cutting this muscle rarely interferes with the ability to control bowel movements and can usually be performed without an overnight hospital stay.

How long does the healing process take after surgery?
Complete healing occurs in a few weeks, although pain often disappears after a few days.

Will the problem return?
More than 90% of patients who require surgery for this problem have no further trouble from fissures.

Can fissures lead to Colon Cancer?
No! Persistent symptoms need careful evaluation, however, since conditions other than fissure can cause similar symptoms.

Anal Warts

What are anal warts?
Anal warts, also called condyloma acuminata, are a relatively common and bothersome condition that affects the area around the anus. They may also affect the skin of the genital area.

They first appear as tiny blemishes, perhaps as small as the head of a pin, and may grow larger than the size of a pea. Usually they do not cause pain or discomfort so many patients may be unaware the warts are present.

Where do these warts come from?
They are thought to be caused by the human papilloma virus which is relatively contagious. The virus can be transmitted from person to person, almost always by direct contact.

Do these warts always need to be removed?
Yes. If they are not removed, the warts can grow larger and become more numerous. There is evidence these warts can become cancerous if left untreated for a long time.

What treatments are available?
If warts are very small and are located only on the skin around the anus, they can be treated with medications applied directly to the surface of the warts. While relatively simple in concept, to prevent injury to the normal skin surrounding the warts this must be done with great care and precision by a physician. This treatment usually requires several applications at various intervals over several weeks.

Another form of treatment involves more rapid destruction of the warts using electrical cautery, surgical removal or a combination of the two. Laser surgery may also be used in some cases. These procedures provide immediate results. Depending on the number and location of warts, these treatments must be performed using either a local anesthetic, such as novocaine, or a general or spinal anesthetic.

Warts inside the anal canal usually are not suitable for treatment by medications, and in most cases need to be treated by cauterization or surgical removal.

Must I be hospitalized for treatment?
No. Almost always, the cautery and excision technique can be performed on an outpatient basis, and the patient can go home after the procedure.

How much time will I lose from work after a cautery treatment?
This depends on each individual situation and the extensiveness of warts removed. Most people are moderately uncomfortable for a few days after treatment, and pain medication may be prescribed. Depending on the extent of the disease, some people return to work the next day, while others may remain out of work for several days.

Will a single treatment cure the problem?
Not in most cases, unfortunately. Even with the cautery and surgical treatments that immediately destroy existing warts, many patients develop new warts after treatment.

This occurs because viruses that cause the warts can live concealed in tissues that appear normal for up to 6 months or longer before another wart develops. New warts often develop from the virus that was already present in the tissue, but these are not recurrences of warts already treated.

As new warts develop, they usually can be treated in the physician’s office, using either a chemical solution or the electrical cautery procedure. These treatments are performed every few weeks initially, then less frequently as new warts become smaller and less numerous.

Sometimes new warts develop so rapidly that office treatment would be quite uncomfortable. In these situations, a second and occasionally third outpatient surgical visit may be recommended.

How long is treatment usually continued?
Follow-up visits are necessary for some months after the last wart is observed to be certain that no more warts occur from viruses living in the cells of skin.

What can be done to avoid getting these warts again?
In some cases, warts may recur repeatedly after successful removal, since the virus that causes the warts often persists in a dormant state in body tissues. To avoid recurrence and reinfection

Observe the area for several months after the last wart was spotted to determine when the warts and the underlying virus that causes them has been eliminated

Abstain from sexual contact with individuals who have anal (or genital) warts. Since many individuals are unaware they suffer from this condition, sexual abstinence or limiting sexual contact to marriage relationships will reduce your potential exposure to the contagious virus that causes these warts. As a precaution, sexual partners ought to be checked, even if they have no symptoms.